NPIMap

Organization Active NPI

Crusaders Central Clinic Association

  • Health Educator
  • Rockford, IL
National Provider Identifier
1841970068
Registry record updated Feb 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health EducatorTaxonomy code 174H00000X
Legal business name
CRUSADERS CENTRAL CLINIC ASSOCIATION
Practice address
1100 Broadway
Rockford, IL 61104-1429
Phone
(815) 490-1600
Fax
(815) 490-1834
NPI assigned
Jul 21, 2023
Last updated
Feb 13, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
CRUSADERS CENTRAL CLINIC ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Peggyanne Davenport
Title
Credentialing Administrator
Phone
(815) 490-1616

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health EducatorGroup: 193200000X MULTI-SPECIALTY GROUP 174H00000X Primary

Addresses

Primary practice location

1100 Broadway
Rockford, IL 61104-1429

Mailing address

1200 W State St
Rockford, IL 61102-2112
Phone (815) 490-1600

National Provider Directory

National Provider Directory
Tax ID family
Crusaders Central Clinic10 organizations share this tax ID, including this one
Part of
Crusaders Central Clinic

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739404800000",
    "number": "1841970068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611022112",
            "telephone_number": "815-490-1600",
            "fax_number": "815-490-1834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 BROADWAY",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611041429",
            "telephone_number": "815-490-1600",
            "fax_number": "815-490-1834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRUSADERS CENTRAL CLINIC ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CRUSADERS CENTRAL CLINIC ASSOCIATION",
        "enumeration_date": "2023-07-21",
        "last_updated": "2025-02-13",
        "certification_date": "2025-02-13",
        "status": "A",
        "authorized_official_last_name": "DAVENPORT",
        "authorized_official_first_name": "PEGGYANNE",
        "authorized_official_title_or_position": "CREDENTIALING ADMINISTRATOR",
        "authorized_official_telephone_number": "815-490-1616"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.